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F4CP Making a High-Impact Impression
The Foundation for Chiropractic Progress has released details of its 2016 strategy, certain elements of which are already in play. The strategy includes ads, posters and other resources available to all F4CP members.
Your Billing Questions Answered
I hear a lot of the following questions: I am afraid I may doing something illegal. I have heard I cannot have different fees for the same service.
Dietary Fat and Prostate Cancer: An Important Update
K.M. Di Sebastiano and M. Mourtzakis published a review paper examining the role of dietary fat on prostate cancer development and progression late last year that does a stellar job of summarizing the available data on fat and prostate cancer.
Tailor-Made Knee Pain: The Sartorius Muscle
A patient was referred to my office after receiving treatment from various providers with no results. The patient was training for the Olympics as a marathon runner and was unable to run or walk without severe medial knee pain.
Diagnose Sprain Injuries in MVA Cases With Dynamic X-Rays (Pt. 1)
Am I the only person to notice hospitals are doing a seemingly insufficient job lately in their initial radiological workup of motor vehicle accident (MVA) victims?
Targeting the Bad Apples in the Bunch
While everyone was focused on the conversion to ICD-10, the Office of Inspector General for Health and Human Services released a new report on chiropractic titled "CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services."
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 2
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
Mechanism: Experimental Approaches to Understanding Acupuncture, Part 1
The clinical benefits of acupuncture are difficult to ignore, but also can be difficult to explain to a Western audience. For nearly 50 years, relentlessly inquisitive scientists and physicians have been working toward a conceptual model to explain acupuncture.
Pro-Con: Swaddling for Newborns
The practice of swaddling has been used for thousands of years and was popular until the 1700s, when it was slowly abandoned by many cultures that considered it old-fashioned or barbaric.
Which Way is the Energy Going? Are You Burning Yourself Out?
One of the simple methods that I use to define Yin/Yang theory to patients is to ask the question, "Which way is your energy going?"
The Concussion-Subluxation Complex
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.
Designing a Fitness Plan (Part 1)
It doesn't matter if you come to my practice for pain relief, weight loss, healthy aging or something else. The formula I talk about for each patient's fitness strategy is pretty much the same.
It's Time to Review
It is amazing to see the changes that are occurring in the acupuncture profession. Let's look at some of the news and events that have contributed to this growth and awareness.
North Carolina Acupuncture Board Files Dry Needling Lawsuit
In early September, the NCALB filed a complaint against the North Carolina Board of Physical Therapy Examiners over the issue of dry needling, a form of acupuncture that uses solid needles to puncture the skin and muscle tissue to relieve pain.
The Modern Application of Ancient Mei Rong
Chinese Medical Cosmetology (Mei Rong) has a well-documented and venerated history dating back to the Qin (221-206 BC) Dynasty.
Born to Energize the Human Spirit: Recollections of Sig Miller
Sig Miller, longtime executive director of the Association of New Jersey Chiropractors (ANJC), passed away on Sept. 17 after a long battle with cancer.
Making Sense of an Increasingly Obvious Conclusion
Where's U.S. health care heading? Like it or not, the list of telltale signs is growing to a point that stands out to even the most myopic observer. Consider this list of facts as you look into the future of health care in the United States:
Syncretism: Acupuncture and Public Health in Cuba
"Syncretism" is defined as a union of diverse tenets or practices. On a recent trip to Cuba designed to demonstrate the integration of Traditional Medicine and biomedicine, our group witnessed this union firsthand.
Too Many to Remember: Tips to Revive Your Ortho / Neuro Test Skills
When I was at Palmer in the mid-1980s, we were given a set of notes in one of our diagnostic courses. The notes covered approximately 70 orthopedic and neurological tests for various regions of the body.
Footsteps of the Sages: An Apprenticeship with Dr. Kezhan Zhang
When I met Dr. Kezhen Zhang in May 2013, I was his translator and the integrity, creativity, and passion he demonstrated as a practitioner and advocate of the medicine convinced me to travel to Beijing to study with him.
Acupuncture and Oriental Medicine in the West
We know acupuncture and Oriental medicine as the indigenous medicine of East Asia; in particular China, Korea and Japan are the countries of origin of this wonderful healing system.
One Size Does Not Fit All: Exercise and Nutrition According to Your Yin/Yang Body Type
There are countless new exercise and nutrition plans out there, emphasizing the latest ground-breaking research and claiming to revolutionize the way we view health.
Omega-3 Fish Oil: An Underappreciated Element of Men's Health
As a clinician with many male patients -- and as a man myself -- I am all too aware of the fact that we like to convince ourselves that we are doing great, when that may be the farthest thing from the truth.
July, 2008, Vol. 08, Issue 07
The Role of the Q Angle in Anterior Knee Pain
By Whitney Lowe, LMT
Postural distortions can lead to numerous soft-tissue disorders. Clients with these postural challenges often look to the massage therapist to help with the pain or biomechanical challenges that result.In the lower extremity, a large quadriceps angle, more commonly called the Q angle, is a postural distortion involving patellofemoral biomechanics. An exaggerated Q angle can lead to knee pain and knee pathologies, as well as compensations in other regions of the body.1
The degree of the Q angle is determined by measuring two lines superimposed on the lower extremity. One line begins at the tibial tuberosity and continues in a superior direction through the midpoint of the patella. A second line connects the anterior superior iliac spine (ASIS) with the midpoint of the patella. The angle between these two lines is the Q angle (Figure 1).
There is a disagreement in the research literature about what constitutes an exaggerated Q angle. Some sources say a Q angle as small as 10 degrees can be a problem, while others say it is not an issue until the angle is greater than 20 degrees.2 A challenge with evaluating the Q angle's role is it's not easy to accurately measure the angle. However, repeated investigations have shown people with a larger Q angle have a greater likelihood of developing numerous knee complaints.
To understand how the Q angle contributes to knee pathologies, it's helpful to look at the anatomical relationships in the region. The patella is embedded in the quadriceps tendon. There is a ridge on the underside of the patella that must fit in the trochlear groove between the two condyles of the femur (Figure 2). The patella moves superiorly and inferiorly in this groove during knee flexion and extension.
The patella's ability to track straight in the trochlear groove is determined by the quadriceps' angle of pull. When the Q angle is greater, the quadriceps pull the patella in a more lateral direction. The unequal pull on the patella causes increased tensile stress on soft tissues around the knee. Too much lateral pull on the patella also can drag it against the lateral femoral condyle and eventually cause degeneration of the cartilage on the underside of the patella - a condition known as chondromalacia patellae. Problems associated with the patella and its correct movement during flexion and extension are referred to as patellar tracking disorders. In addition to patellar tracking disorders, a larger Q angle also can be a major factor in patellar subluxation or dislocation, as well as anterior cruciate ligament sprains.
There is an increased incidence of these knee disorders in women and individuals with genu valgum. The Q angle is greater in women due to the wider pelvis, which places the ASIS farther away from the patellar midline, thereby increasing the Q angle. The Q angle also is greater in people who have the genu valgum postural distortion, more commonly known as knock-knees.
Because certain aspects of bony structure, such as a wide pelvis, determine the Q angle, it's difficult to alter the angle with soft-tissue work alone. However, treatments such as massage are helpful for addressing some of the factors that aggravate Q angle problems. For example, an imbalance in tightness between the vastus lateralis and vastus medialis muscles can contribute to patellar tracking disorders. If the vastus lateralis is too tight, it can pull the patella farther in a lateral direction. This situation often occurs in people with a larger Q angle. Comprehensive massage treatment of the vastus lateralis can reduce the distance it pulls the patella in a lateral direction.
There are numerous causes of anterior knee pain. Several of these can be related to an excessive Q angle. It's not necessary to pull out the protractor and determine the exact Q angle. However, a visual estimation of the Q angle can give important clues about the role this postural distortion plays in a variety of pain complaints. In those cases, massage treatment of the quadriceps muscle group and the retinacular fibers around the patella greatly helps reduce the detrimental results of a large Q angle.
Click here for more information about Whitney Lowe, LMT.
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